Congestive heart failure chest x ray: Difference between revisions
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{{congestive heart failure}} | {{congestive heart failure}} | ||
{{CMG}} | {{CMG}}; {{AOEIC}} {{LG}} | ||
== Overview== | == Overview== | ||
| Line 6: | Line 6: | ||
==Chest X-ray== | ==Chest X-ray== | ||
* Since the | *Since the left ventricle often dilates in the anteroposterior direction, the cardiac silhouette may appear deceptively normal. | ||
Chest x-ray findings include: | *Chest x-ray findings include: | ||
#[[Kerley B lines]] or thickening of the interlobular septa | #[[Kerley B lines]] or thickening of the interlobular septa | ||
#[[Peribronchial cuffing]] | #[[Peribronchial cuffing]] | ||
| Line 16: | Line 16: | ||
#[[Interstitial edema]] | #[[Interstitial edema]] | ||
#[[Pleural effusion]]s | #[[Pleural effusion]]s | ||
====Kerley B Lines==== | |||
[[Kerley B lines]] are short parallel lines at the lung periphery. These lines represent distended interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the [[pleura]]. They are located peripherally in contact with the pleura, but are generally absent along fissural surfaces. They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs. | |||
<gallery> | |||
Image:Kerley B 001.jpg|Plain film: [[Mitral stenosis]], Kerley B lines | |||
Image:Kerley B 002.jpg|Plain film: [[Mitral stenosis]], Kerley B lines | |||
Image:Kerley B 003.jpg|Plain film: [[Mitral stenosis]], Kerley B lines | |||
</gallery> | |||
<br clear="left"/> | |||
====Peribronchial Cuffing==== | |||
[[Image:Peribronchial cuffing.png|thumb|left|The red arrows point to thickened bronchial walls that have a doughnut-like appearance.]] [[Peribronchial cuffing]] is an abnormality on a chest x-ray whereby the usually thin bronchial walls are thickened and take on a doughnut-like appearance.<br clear="left"/> | |||
====Cephalization==== | |||
[[Image:Cephalization.png|left|thumb]]Cephalization refers to the redistribution of blood into the upper lobe vessels. It has been hypothesized that once the hydrostatic pressure exceeds 10 mm Hg, then fluid begins to leak into the interstitium of the lung. This excess fluid initially compresses the lower lobe vessels, perhaps as a result of gravity. After this, the upper lobe vessels are recruited to distribute a greater volume of blood. In order to carry a greater volume of blood, the upper lobe vessels increase in size.<br clear="left"/> | |||
==Differentiating Cardiogenic Versus Noncardiogenic Pulmonary Edema== | ==Differentiating Cardiogenic Versus Noncardiogenic Pulmonary Edema== | ||
==Cardiogenic Pulmonary Edema== | ===Cardiogenic Pulmonary Edema=== | ||
[[Image:Interstitial edema.png|thumb|left]] Cardiogenic pulmonary edema can be distinguished from noncardiogenic pulmonary edema by the presence of redistribution of blood flow to the upper lobes (increased blood flow to the higher parts of the lung) and interstitial edema. | [[Image:Interstitial edema.png|thumb|left]] Cardiogenic pulmonary edema can be distinguished from noncardiogenic pulmonary edema by the presence of redistribution of blood flow to the upper lobes (increased blood flow to the higher parts of the lung) and interstitial edema. | ||
<br clear="left"/> | |||
==Noncardiogenic Pulmonary Edema== | ===Noncardiogenic Pulmonary Edema=== | ||
[[Image:Pulmonary alveolar edema.png|left|thumb]] In contrast, patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema. | [[Image:Pulmonary alveolar edema.png|left|thumb]] In contrast, patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema. | ||
<br clear="left"/> | |||
==Correlation of Chest X-Ray Findings with Pulmonary Capillary Wedge Pressure== | ==Correlation of Chest X-Ray Findings with Pulmonary Capillary Wedge Pressure== | ||
| Line 35: | Line 50: | ||
* '''Pulmonary Alveolar Edema''': > 25 mm Hg | * '''Pulmonary Alveolar Edema''': > 25 mm Hg | ||
== | ==ACC/AHA Guidelines- Chest X Ray Recommendation (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>== | ||
{{cquote| | |||
< | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]=== | ||
'''1.''' Twelve-lead [[electrocardiogram]] and [[Congestive heart failure chest x ray|chest radiograph]] (PA and lateral) should be performed initially in all patients presenting with [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}} | |||
==Vote on and Suggest Revisions to the Current Guidelines== | |||
*[[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure | The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]] | |||
== | ==Guidelines Resources== | ||
[ | *[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult] <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref> | ||
*[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation] <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref> | |||
== References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{ | [[Category:Disease]] | ||
{{ | [[Category:Cardiology]] | ||
[[Category:Emergency medicine]] | |||
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{{WikiDoc Sources}} | |||
Revision as of 15:32, 4 April 2012
| Congestive Heart Failure Microchapters |
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Pathophysiology |
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Differentiating Congestive heart failure from other Diseases |
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Diagnosis |
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Treatment |
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Medical Therapy: |
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Surgical Therapy: |
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ACC/AHA Guideline Recommendations
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Specific Groups: |
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Congestive heart failure chest x ray On the Web |
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Directions to Hospitals Treating Congestive heart failure chest x ray |
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Risk calculators and risk factors for Congestive heart failure chest x ray |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
The chest x-ray in the patient with heart failure shows cardiomegaly (cardiac enlargement and pulmonary congestion (Kerley B lines, and in some cases pleural effusion)
Chest X-ray
- Since the left ventricle often dilates in the anteroposterior direction, the cardiac silhouette may appear deceptively normal.
- Chest x-ray findings include:
- Kerley B lines or thickening of the interlobular septa
- Peribronchial cuffing
- Thickening of the fissures
- Cephalization
- Increased vascular markings
- Interstitial edema
- Pleural effusions
Kerley B Lines
Kerley B lines are short parallel lines at the lung periphery. These lines represent distended interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the pleura. They are located peripherally in contact with the pleura, but are generally absent along fissural surfaces. They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs.
-
Plain film: Mitral stenosis, Kerley B lines
-
Plain film: Mitral stenosis, Kerley B lines
-
Plain film: Mitral stenosis, Kerley B lines
Peribronchial Cuffing
Peribronchial cuffing is an abnormality on a chest x-ray whereby the usually thin bronchial walls are thickened and take on a doughnut-like appearance.
Cephalization
Cephalization refers to the redistribution of blood into the upper lobe vessels. It has been hypothesized that once the hydrostatic pressure exceeds 10 mm Hg, then fluid begins to leak into the interstitium of the lung. This excess fluid initially compresses the lower lobe vessels, perhaps as a result of gravity. After this, the upper lobe vessels are recruited to distribute a greater volume of blood. In order to carry a greater volume of blood, the upper lobe vessels increase in size.
Differentiating Cardiogenic Versus Noncardiogenic Pulmonary Edema
Cardiogenic Pulmonary Edema
Cardiogenic pulmonary edema can be distinguished from noncardiogenic pulmonary edema by the presence of redistribution of blood flow to the upper lobes (increased blood flow to the higher parts of the lung) and interstitial edema.
Noncardiogenic Pulmonary Edema
In contrast, patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema.
Correlation of Chest X-Ray Findings with Pulmonary Capillary Wedge Pressure
- Normal:5-10 mm Hg
- Cephalization: 10-15 mm Hg
- Kerley B Lines: 15-20 mm Hg
- Pulmonary Interstitial Edema: 20-25 mm Hg
- Pulmonary Alveolar Edema: > 25 mm Hg
ACC/AHA Guidelines- Chest X Ray Recommendation (DO NOT EDIT) [1][2]
| “ |
Class I1. Twelve-lead electrocardiogram and chest radiograph (PA and lateral) should be performed initially in all patients presenting with heart failure. (Level of Evidence: C) |
” |
Vote on and Suggest Revisions to the Current Guidelines
Guidelines Resources
- The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult [1]
- 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation [2]
References
- ↑ 1.0 1.1 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
- ↑ 2.0 2.1 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967